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Official websites use. Share sensitive information only on official, secure websites. Email: WShaocheng gmail. DSM-V-defined substance use disorder comprises four groups of symptoms: impaired control, social impairment, risky use, and pharmacological reactions. Behavioral patterns of impaired control, including impulsivity and risk taking, are associated with HIV risk behaviors. Substance users with stronger craving symptoms are more likely to use drugs via intravenous injection than other routes because of the faster drug effect and the higher bioavailability; thus, they are at high risk of HIV infection. Public health policies such as Needle and Syringe Exchange Programs and medication-assisted treatment are proven to reduce HIV risk behaviors such as the frequency of intravenous injection and even the incidence of HIV infection, but both of them have limitations. While intravenous injection is a frequently discussed issue in public policies and the HIV-related literature, it is a much less frequent topic in the addiction literature. Substance use disorder is a complex phenotype, and is the result of a series of causal influences such as genetic factors, diverse environmental factors, and predicted drug-induced effects 1 — 4. Several behavior patterns such as impulsivity, risk taking, and stress response resulting from specific personality and physiological traits are considered to contribute to the vulnerability or liability to addictive disease, partially accounting for the influence of genetic variation, indexed as heritability, on addiction. Substance use disorder is complicated in its symptoms and signs, which involve several domains such as cognition, behavior, and physiology. Persistent substance use changes brain reward circuits and causes specific behavior patterns such as craving. According to DSM-V, the criteria of substance use disorder can be grouped into four groups: impaired control, risky use, biological reactions, and social impairment caused by substances. Impaired control includes taking larger amounts than originally intended, multiple unsuccessful efforts to decrease or discontinue use, spending a great deal of time on substance use, and craving. The development of substance tolerance and withdrawal comprise the biological reactions 6. DSM-V defines symptoms such as tolerance, withdrawal, and uncontrolled increasing intake as the basic elements of substance use disorders, and these symptoms are associated with intravenous drug use. As a result of tolerance development, the longer these symptoms persist, the greater the amount of drug the user needs to consume to have the same effect. Among the most frequent and tolerant drug users, injection is more common, because injection causes an immediate and strong drug effect, leading to frequent reuse of contaminated needles and needle sharing. DSM-V also defines impaired control and risky use as the other two basic elements of substance use disorders, which are also associated with intravenous drug use. When severe substance abusers exhibit strong craving and impaired self-control, there is a desire to experience the drug effect immediately, ignoring the hazard of blood-borne diseases, such as HIV, hepatitis B, and hepatitis C. Impulsivity is an internal mental urge and impaired self-control is associated with poor judgment. Impulsivity and impaired self-control are the tendency to act without forethought, leading to increased external risky behaviors such as unsafe intravenous drug use. We hope this review may provide insight into all possible avenues that can be explored in current and future public health approaches to reducing the spread of HIV infection by reducing injection rates. According to DSM-IV, the criteria of substance use disorder include tolerance, withdrawal, uncontrolled increasing intake, spending more time and money on substances, and impaired social, occupational, or recreational function, and use that continues in spite of knowledge of the impact of substance on physical and psychological health 7. In , DSM-V was published and revealed the criteria change of substance-related disorders. DSM-V removed the criterion of recurrent substance use resulting in legal problems and added the criterion of craving to use substance, and kept all other criteria from DSM-IV. Furthermore, the criteria of DSM-V substance use disorder can be used to specify current severity, with mild, moderate, and severe 6. A categorical view is used by clinicians to meet the needs of reporting for health care planners; on the other hand, a dimensional approach conceptualizes a quantitative disorder that is more useful for the purpose of research 8. Several routes of drug administration are commonly used by substance abusers: oral, sniffing or intranasal using, and injection. Injection can cause several side effects, including high fever, pain over the injection site, swelling or hardness under the injection site, and anaphylaxis. Compared with the other administration routes, intravenous injection results in the fastest drug effect because the drug reaches the brain through the circulatory system almost immediately. In brief, compared with other drug administration routes, substances have the strongest and fastest effect via intravenous injection. Intravenous injection and needle sharing are a consequence of severe forms of drug addiction. For example, it is common for PWID to inject heroin multiple times per day, thereby reusing or sharing needles due to limited resources. Because of the fast drug effect on the brain, the highest bioavailability, and cost, intravenous injection and sharing of needles are more among the PWID with the most severe craving symptoms. With more severe craving symptoms, substance abusers are at higher risk of risky behaviors and are more likely to use drugs impulsively, regardless of the hazard of blood-borne diseases 6. Injection behavior is very common among severe substance abusers. Drug addiction is associated with several psychiatric conditions including psychosis, mood disorders, depression, suicide, violence, and aggression; consequently, many PWID suffer from multiple morbidities and lose family support and occupational functioning. As a result, drug addiction causes serious social problems, with a substantial human and financial cost. In , worldwide, an estimate showed that million people have used at least one illicit drug, 39 million opioid, amphetamine, or cocaine users, and 21 million people who inject drugs This estimate excluded several kinds of illicit drug—3,4-methylenedioxy-N-methylamphetamine MDMA or ecstasy , hallucinogens, and inhalants—so the true numbers of illicit drug users may be higher. Opioid overdose and opioid dependence are potentially lethal; injection of opioids, cocaine, or amphetamine is a substantial risk factor for transmission of HIV, hepatitis C, and hepatitis B The prevalence of opioid use disorder, amphetamine use disorder and cocaine use disorder were 0. Based on the result of the Monitoring the Future study, the number of injecting heroin users has fluctuated in recent years, with the annual prevalence rising from 0. In Western countries, almost 3. In the next paragraph, we review the previous studies which link HIV infection and PWID, and the related approaches to reduce the frequency of injection behavior. The transmission pathway was identified as spreading through certain body fluids such as blood, semen, vaginal secretions, and breast milk. Several preventive measures were implemented such as risk reduction programs, condom distribution, and needle exchange programs. The infection trend decreased from but then steadily increased from to Currently, highly active antiretroviral therapy HAART , which combines at least three drugs from two classes of antiretroviral agents, is used to treat HIV However, this virus is highly mutable so drug resistance may develop. Prevention is a good alternative to reduce HIV transmission. Ten years after HIV was first described, three main transmission routes were identified: blood-to-blood, sexual, and perinatal. Transmission by blood included transfusion of blood and blood products, needle sharing among intravenous drug users, and injection with unsterilized needles. A host of behavioral risk patterns, now defined as HIV risk behaviors, are observed in those at highest risk of HIV infection, including injection drug use and sexual behaviors including multiple partners, sex trade, and sex without using condom 24 , Injection drug use, which is becoming increasingly associated with severe substance dependence, is also a well-known transmission pathway for HIV infection 26 — Rosenberg et al. Dutra et al. Carroll and Onken reviewed the literature and found support for behavioral and pharmacological treatment effects on drug abuse, and that combinations of behavioral and pharmacological treatments have better potency than either one alone Two randomized clinical trials found that the Holistic Harm Reduction Program with behavioral therapy reduced HIV risk behaviors and improved adherence to medical treatment among intravenous drug users 32 , A systematic review by Mathers et al. The high HIV incidence among PWID in many developing countries can be controlled by key harm reduction and treatment interventions such as needle and syringe programs, medication-assisted therapy MAT , HIV counseling and testing, and antiretroviral therapy In addition, opioid substitution is being used to reduce the prevalence of HIV infection, thereby causing modest reduction in HIV transmission rates NSEP is a public health innovation which provides clean needles and syringes to reduce the time that contaminated needles are in circulation. NSEP also offers legal, social and health counseling, sex education, and referrals to medical services as part of comprehensive approaches 37 , While the range of NSEP practices varies broadly by country, needles and syringes are available for free from vending machines and pharmacies in some countries in Europe and Australia The theory behind NSEP is that the less time the contaminated needles and syringes are in use; the less likely they are to be used by uninfected drug users. There is strong evidence that NSEP reduces the frequency of injection behavior with contaminated devices. Separate reviews by Drucker et al. MacArthur et al. A review by Sawangjit et al. Noroozi et al. Fernandes et al. Heroin, cocaine, and amphetamine are the three most commonly injected drugs, but only heroin agonist pharmacotherapy is available for treating heroin addiction. Hence, this review only focuses on heroin agonist pharmacotherapy, also called substitution or maintenance pharmacotherapy. The best-known heroin substitution treatment, methadone maintenance therapy, is the standard protocol for treating heroin addiction Methadone is a long-acting synthetic opiate agonist. It is initially administered in low doses to prevent respiratory depression and the dose is gradually raised to a maximum and maintain at that level in order to minimize withdrawal symptoms. Methadone doses at a high level can block the superimposed effects of heroin, so the PWID does not experience euphoria when they inject heroin under this treatment 48 , In addition, methadone can be taken orally, thus reducing cues associated with injection behaviors in PWID Methadone maintenance treatment has proven effective in reducing heroin use after 24 months of treatment, and the longer patients remain in the treatment program the better the results Remaining in a treatment program longer can bring about a range of positive outcomes, for example, improved family relationships, more stable employment, and fewer legal problems Dutta et al. HIV seroconversion is associated with the length of time in methadone maintenance treatment In addition to methadone, buprenorphine and naltrexone are currently two other medications for opioid addiction Long-acting injectable naltrexone can block opioid receptors and decrease the feeling of craving, as well as the risk of overdose Naltrexone implants also had a lower mortality rate than buprenorphine 57 , and a randomized clinical trial supported that long-acting injectable naltrexone was as safe and effective as buprenorphine with naloxone Intravenous injection is strongly associated with HIV infection. This global spread of HIV infection ultimately results in dramatic loss of health and financial productivity. Intravenous injection is very common among PWID with severe craving symptoms as it has the fastest drug effect on brain and the highest bioavailability. Thus, PWID with more severe craving symptoms are more likely to use intravenous injection, regardless of the legal problems and the hazard of blood-borne diseases; in other words, they are more likely to take risks and are more impulsive, which are also associated with other HIV risk behaviors. As mentioned above, intravenous injection can cause local pain, swelling, or hardness over injection sites, and possible anaphylaxis. Intravenous injection, with the fastest drug effect on brain and the highest bioavailability, can relieve craving symptoms. While intravenous injection is a frequently discussed risk factor in the HIV-related literature, it is a much less frequent topic in the addiction literature. However, as there is no proven cure for HIV, the best way to reduce infection rates is to prevent its spread. More effectively identifying those at a high risk of HIV infection is the key. NSEP is a widely used public health innovation which is significantly reducing contaminated needle distribution, but the relationship between NSEP and the incidence of HIV is controversial. Only heroin agonist pharmacotherapy is available for treating heroin addiction in MAT, despite other substance such as cocaine and amphetamine being injectable. While intravenous injection is a frequently discussed target in the public policies, it is a much less frequent topic in the addiction literature. Several key findings are suggested. First, PWID use drugs intravenously because their effects kick in immediately; however, intravenous drug users and those who share needles are at risk of blood-borne diseases. This suggests that PWID will more likely take risks when they become severe substance abusers with stronger craving, needing more drugs to reach the same effect and having impaired self-control. In two small randomized controlled trials, psychosocial interventions also had an effect on reducing the frequency of HIV risk behaviors such as intravenous injection. In this review, we suggest that interventions to reduce the severity of substance use disorder and the frequency of intravenous injection could be beneficial to reducing HIV infection. However, more research is needed to illuminate the biological mechanisms behind intravenous injection and the casual relationship between drug addiction and intravenous injection, so that we can provide more effective strategies for prevention. As a library, NLM provides access to scientific literature. Cell Transplant. Find articles by Shao-Cheng Wang. Find articles by Brion Maher. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

Substance Use Disorder, Intravenous Injection, and HIV Infection: A Review

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The modern era is one of depres- sion and insomnia, of dieting and impotence Fortunately, medications now exist to treat these quasi-illnesses. Baldness, obesity, insomnia, depression, impotence, and hyperactivity all can, with the appropriate drugs, be beaten. Are 'happy pills' and 'sex pills' really improving our quality of life? Do they eliminate worry and depression? Do psychological-physiological pharmaceuticals really offer release? Are they a crutch? Is a life on drugs a dead end, or will these treatments create a new and better world? Early this year, the United States approved a low-dose daily-use version of Cialis, a drug that treats erectile dysfunction ED. Taiwan is likely to follow suit as early as next year. Unlike Viagra and other ED drugs, which have only short-term effects are taken just before 'going into action,' the new version of Cialis allows ED sufferers to take regular doses at regular intervals to ensure that they are always 'primed and ready. Alli is a new weight-loss drug approved for over-the-counter sale in the US. Its dose is lower and its side-effects milder than those of Reductil, which suppresses appetite, and Xenical a higher-dose version of Alli , which blocks the absorption of fat. Though not yet approved for sale in Taiwan, it is already drawing attention here. In fact, many beauty-conscious women have been traveling abroad for the express purpose of buying some. Prozac, Reductil, Viagra, and the hypnotic sleep aid Stilnox These days, everybody has heard of the pharmaceutical industry's 'big hits. Wu says that medical technology has been at a loose end for the last ten years. Life expectancies are stagnating and many infectious diseases have been controlled. The market has therefore turned to bettering humanity's quality of life. Prescription pharmaceuticals may be a convenient means of restoring our mental equilibrium, but they are not the only option. Gardening, keeping pets, diet changes, exercise, and religion are all worth a try. People in the modern era who struggle with tangled emotions ache for release from their anxieties and emotional hurts. Gean Po-wu, a professor in the Department of Pharmacology and assistant dean of the medical school at National Cheng Kung University, is currently working on a drug for the treatment of post-traumatic stress disorder PTSD. Whereas psychological approaches to treating PTSD only ease the symptoms or hide the damage, Gean claims his drug will eliminate victims' fears and bad memories by targeting the central nervous system's NMDA receptors. Though the drug is still undergoing animal testing, the media and the medical community have begun taking notice. Although there are no forgetfulness pills on the market yet, the prospect of their advent is a little unsettling. How many people might really want to use an actual 'water of forgetfulness,' a drug that removed tragic memories? Eternal Sunshine of the Spotless Mind, a film starring comedian Jim Carrey, featured a clinic that erased specific memories at the request of its patients. While undergoing treatment, Carrey's character begins to regret his decision. As past events pass through his mind, he finds the sweet memories hard to let go of. While there may not be an actual 'water of forgetfulness' in the real world, there is a 'happy pill' that pulls people from the depths of their sorrows and improves their relationships. It's called Prozac. Since then, 40 million people around the world have had their lives changed by the drug. Hailed as the most successful drug since penicillin, Prozac not only treats chronic depression, but is also prescribed for the treatment of premenstrual syndrome PMS , bulimia, and obsessive-compulsive disorder. For example, something Mrs. Wu, who suffers badly from PMS, used to spend the week before her period arrived in an emotional maelstrom. If anything rubbed her the wrong way, she would explode in anger. And it wasn't only her husband who suffered. Even her seven-year-old son knew when 'Mommy's period' had come. Now Mrs. Wu needs only to spend five to seven days per month on Prozac to enable her whole family to weather the storm. Prozac works by increasing the concentration of the neurotransmitter serotonin in the brain, affecting the patient's mood and even personality. Though there have been numerous reports from abroad of patients becoming violent, experiencing anxiety, or suffering from insomnia while taking the drug, there is no question that this 'miracle pill' has transformed psychiatry and psychiatric treatment around the world. This rise is not unique to Taiwan. When your life and emotions spin out of control, medication can help you quickly weather the storm and get yourself back on track. But, as helpful as the drugs are, it's frightening to think that they control your life. But people in this modern era aren't just seeking relief from anxiety and depression. They would also very much like help with their insomnia. How many people in Taiwan toss and turn their way through every night? A survey by the Taiwan Society of Sleep Medicine showed that In other words, some 4. Women over the age of 50 suffer at an even greater rate-an estimated one in three rely on hypnotics to get to sleep. In Japan, which is aging rapidly and has been stuck in the economic doldrums for years, the consumption of hypnotics, as measured in defined daily dose for statistical purposes S-DDD per thousand population, was a truly startling From the figures in the National Health Insurance database, Erin Wu, head of psychiatry at the Koo Foundation Sun Yat-Sen Cancer Center, estimates that approximately 4 million Taiwanese take hypnotics prescribed by their doctors every year. These institutions administer sleeping pills to nearly all of their elderly residents to make caring for them easier. The drugs are administered at such heavy doses that seniors can barely keep their eyes open during the day. This, in turn, has led to a high incidence of paralyzing falls. In Taiwan, hypnotics have been designated Class 3 and Class 4 controlled drugs, which means that they can only be obtained with a doctor's prescription. Reductil, Prozac, Stilnox, Viagra Drugs to regulate our minds and bodies abound, treating everything from obesity and depression to insomnia and impotence. It almost as if we've fallen into Huxley's Brave New World. Chien explains that older, barbiturate-type hypnotics decrease the release of neurotransmitters, thereby depressing the central nervous system and calming the patient. However, barbiturates are both dangerous and addictive. Overuse may cause low blood pressure, breathing difficulties, hypoxemia and acidosis, and can be life-threatening. Hypnotics are even more dangerous when mixed with alcohol, which increases their morbidity rate tenfold. In fact, hypnotics are the third leading cause of poisoning in Taiwan. The benzodiazepines developed in more recent years, such as Rohypnol and Erimin, work by binding to specific receptors in the central nervous system. This hyperpolarizes the cell membrane and has a sedative effect. Benzodiazepines have a short half-life, and are safer and better tolerated than barbiturates. In addition, they have a specific antidote and are therefore less likely to cause death by overdose. Hypnotics may have become safer, but their use in Taiwan has also grown rapidly in recent years. The new short-acting non-benzodiazepine hypnotics containing Zolpidem, which binds to BZD-1 receptors in the cerebellum, account for nearly half of these. According to the NBCD, Taiwan's consumption of this class of hypnotics, which act rapidly and wear off in less than six hours, nearly doubled from to , growing from approximately 59 million tablets to more than million in just three years. But there is cause for concern. At excessive dosages, they become long-acting and cause drowsiness on waking. And even a single pill can be misused as a date-rape drug,' he says. There are other risks, too. The best-selling Stilnox, which contains Zolpidem, is a fast-acting sleeping pill that doesn't have a muscle-relaxant effect. As a result, some patients have been discovered sleepwalking, binge eating or drinking, or even driving a car while in a semiconscious state induced by the drug. Other reasons for the rapid increase in the consumption of hypnotics include people's desire for quick solutions to problems, their reluctance to investigate their personal reasons for having insomnia, and their unwillingness to make the kind of long-term physical, psychological, and spiritual adjustments that would improve their sleep. In his view, the problems lurking underneath are far more frightening. Insomnia occurs when brain functions become imbalanced. Treating it effectively requires identifying and resolving the underlying problem or problems, which may include panic, depression, bipolarity, or other issues. When they treat these conditions, their insomnia improves as well. An estimated more than million men around the world suffer from erectile dysfunction. The introduction of Viagra has allowed these formerly dejected men to stand tall again. Viagra's name is a play on 'vigor' and 'Niagara,' suggesting torrents of energy gushing like a waterfall. The Chinese version of the name is similarly suggestive of this little blue pill's power and appeal. In just ten years since then, more than 15 million men in more than nations have used the drug. Viagra was formally approved for use in Taiwan in March of But, for all that departments of urology have prescribed it at an incredible pace an average of three pills per minute , smuggling and counterfeiting are rampant. Interestingly, the little blue pill's incredible sexual potency was unexpected. Pfizer developed the drug to treat angina, and considered shelving it when it performed poorly in human testing. But when Pfizer tried to reclaim leftover pills from study participants, it discovered that many didn't want to return them. When the company learned that erections were one of the drug's side effects, it changed course and began developing the drug as a treatment for impotence. As Dr. Huang Shih-tsung, an attending physician in Chang Gung Memorial Hospital's urology department, has written, Viagra doesn't itself cause the corpus cavernosum to fill with blood. Instead, it acts by inhibiting the breakdown of cyclic guanosine monophosphate in the corpus cavernosum. In other words, Viagra is no aphrodisiac. For the drug to work, you have to be 'in the mood' as well. The underlying causes of male impotence are complex. They can be physical, psychological, or even age-related. One little pill cannot address them all. Whether depression, insomnia, or impotence, pharmaceuticals address only the symptoms. But what's really frightening about pharmaceuticals is that they can become 'club drugs. It can't help but make you wonder where we draw the line between legal pharmaceuticals and illegal drugs. Take MDMA, for example. Originally developed by a German pharmaceuticals company as a diet medication, it was found to cause hallucinations and never marketed. An amphetamine derivative, MDMA reduces inhibitions, creating a sense of intimacy and the desire to speak about your inmost feelings. Some psychiatrists therefore used it in the s to assist hypnosis, even though it was not approved by the FDA. When the medical community later realized the drug was toxic, it stopped using it. MDMA then moved into the club scene, where it became a popular party drug. The NBCD's Chien Chun-sheng says that what distinguishes pharmaceuticals and 'narcotics' is, by definition, the fact that the former are legal and the latter not. In other words, people choose where to draw the line between the two categories, and new evidence or new discoveries can move that line. Should we then avoid the use of all these pharmaceuticals? Should we be less willing to try them? That's certainly many people's view. They feel that insomnia, depression, anxiety, and panic aren't 'real illnesses. And people who haven't experienced these disorders really can't understand the suffering they entail. He treats many patients in their 60s, the kind of people who were the foundation of Taiwan's economic success. The medications help them deal with what would otherwise be unbearable psychological pain, and enable them spend their last years in peace. While there may be nothing wrong with psychiatric drugs in themselves, they should be used with great care and paired with other psychological treatments. According to Hsu, medications shouldn't be prescribed immediately even in the treatment of conditions such as hypertension and diabetes. Patients should first spend three months attempting to control their conditions through diet and exercise. The causes of psychological disorders are much more complex. Should we really just be throwing pills at them? Her reactions slowed by the drugs, she ended up hitting someone with her car. Four years later, she still gets upset at the memory. Though the hypnotics helped her get to sleep, she says they never left her feeling fully rested. On weekends, away from the pressures of work, she tried to do without them, too. But she experienced withdrawal symptoms that included heart palpitations, intense dreams, restless sleep, breathlessness, and a racing pulse. These days, she walks her dog, hikes, and drinks wine instead of taking sleeping pills. Though she still can be sluggish after her occasional restless nights, she says, 'I just push on through. The casualness with which drugs are prescribed is the result of habit and inertia on the part of both doctors and patients. The data shows that talking cures are effective on their own. But they are time consuming and expensive, two things people today have a hard time accepting. But instead of allowing themselves to slow down and examine which aspects of their lives might be off track, they pretend these signals are just instances of their bodies 'not listening. They don't want to question their goals or allow their condition to slow them down. In its current form, Taiwan's National Health Insurance system encourages doctors to view their work as writing prescriptions. But the sheer number of patients has long encouraged the majority of the psychiatric community to interpret everything in terms of neurotransmitters,' says Dr. Su says that another school of psychiatric thought is oriented towards helping patients find the right path forward, and believes in a reciprocal relationship between mind and body. They help them untie the knots and work through their problems. After the accident, he was constantly upset by the ever-present memory of his injury. He dealt with it by reminding himself, 'At least I'm still alive. Should we or should we not use pharmaceuticals to 'improve' our lives? Opinions are hugely divided. Isn't that the same principle? He argues that far more people have died from smoking than from taking medication. In his view, the benefits of pharmaceuticals far outweigh the harm. On the other hand, Liang Chung-yi, a counseling psychologist at the Ko-yan Counseling Center, is against relying on drugs. In her view, there is a distinction between severe depression and its milder cousin, dysthemia. People who experience severe depression feel like walking corpses, with no 'vital spark. However, most patients suffer from dysthemia arising from non-physiological causes. These patients should, at the very least, undergo counseling, which seeks to understand the links between a patient's moods and thoughts, concurrently with the administration of medication. Liang believes that when doctors prescribe medication as a quick-and-easy solution, patients lose the opportunity to better understand themselves. Hsu believes we are on the wrong track, and worries about a future in which everyone is on medication. Who would have thought that Aldous Huxley's Brave New World would become our workaday reality, yet here we have Prozac playing the role of soma. But can we quit Prozac? And would giving it up lead us to a truly better world? Richard W. Hartzell, an American-born author who has spent nearly 50 years in Taiwan, wrote that century eggs might be the most representative Taiwanese food, because they utterly baffled the imaginations of foreign observers What kind of food carries on the dietary knowledge and wisdom of past generations while also being popular with contemporary gourmets and gourmands? In February of , badminton player Chou Tien-chen announced that in early he had been diagnosed with early-stage colon cancer. While the planet finds itself sweating under the blazing sun, a feeling of fraternity is spreading across the globe like wildfire. As the host of the first Olympic games since the end of the Covid pandemic, Paris is the cent The truffle grows in areas be Life rarely goes according to plan. But modern pharmaceuticals offer relief to those experiencing unremitting psychological distress. Many now turn to them for energy, happiness, and sleep. Are we entering an era in which drugs promise us the semblance of a perfect life? A changed personality? Hypnotics But people in this modern era aren't just seeking relief from anxiety and depression. Hypnotics are widely used in the world's developed nations. A different sedative? The tip of the iceberg But there is cause for concern. Impotence drugs Pharmaceuticals companies are now selling pills to restore sexual vigor, too. Legal 'drugs' Whether depression, insomnia, or impotence, pharmaceuticals address only the symptoms. Beginning with the heart Should we or should we not use pharmaceuticals to 'improve' our lives? 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